79例患者院前心跳呼吸骤停采取心肺复苏的临床分析

Clinical analysis of 79 patients with pre-hospital cardiopulmonary arrest treated by cardio-pulmonary resuscitation measures

目的 探讨院前急救心跳呼吸骤停患者的有效抢救措施。方法 选取本院院前急救患者79例为研究对象,从心跳呼吸骤停后开始复苏时间、抢救半径、现场有无目击者参与、气管插管耗时（含气囊—面罩给氧）、是否使用电除颤等方面进行相关因素分析。结果 79例患者中,心肺复苏成功抢救患者7例,抢救成功率8.86%。心跳呼吸骤停后开始复苏时间〈4 min与开始复苏时间≥4 min心肺复苏（CPR）成功率差异有统计学意义（P〈0.05）。开始复苏时间〈4 min能有效提高CPR复苏成功率（OR=13.64,95%CI：1.43~130.08）;在院前急救心跳呼吸骤停患者的过程中,抢救半径〈5 km、气管插管（含气囊—面罩给氧）耗时〈90 s及现场有目击者参与的情况下和抢救半径≥5 km、气管插管（含气囊—面罩给氧）耗时≥90 s及现场无目击者参与,CPR复苏成功率差异有统计学意义（P〈0.05）。使用电除颤是CPR复苏成功要素之一（OR=10.00,95%CI：1.14~87.59）。结论 79例患者临床分析表明,院前急救患者心跳呼吸骤停后开始复苏时间早,抢救半径短,气管插管（含气囊—面罩给氧）耗时少和有目击者参与是影响CPR复苏成功的关键因素,实施专业化院前急救可提高院前心肺复苏成功率。

Objective To discuss effective pre-hospital rescue measures of cardiopulmonary arrest patients. Methods A total of 79 patients with pre-hospital rescue were selected as research subjects, the related factors including resuscitate time from cardiopulmonary arrest, rescue radius, eyewitness available or not, time consuming of endotracheal intubation （airbag-mask oxygen inhala- tion） and whether using defibrillators or not were analyzed. Results There were 7 successful cardio- pulmonary resuscitation （CPR） cases in 79 patients, with CPR success rate of 8.86%. There were significant difference in cardio-pulmonary resuscitation（CPR） between less than 4 min and more than 4 min of resuscitate time. When time between cardiopulmonary arrest and CPR was less than 4 min, CPR success rate could be effectively improved （ OR = 13.64, 95% CI ： 1.43 - 130.08）. During the rescue procedure of pre-hospital cardiopulmonary arrest, the success rate of CPR was statistically sig- nificant when comparing rescue radius less than 5 km, time consuming of endotracheal intubation （ in- cluding airbag-mask oxygen administration） less than 90 s with rescue radius not less than 5 km, time consuming of endotracheal intubation （including airbag-mask oxygen administration） not less than 90 s, no witness involved （P 〈 0.05 ）. Using defibrillators was one of the CPR success factors （ OR = 10.00,95% CI： 1.14- 87.59 ）. Conclusion The clinical analysis of 79 patients shows that key influencing factors for CPR success rate are less time from cardiac arrest to CPR , less radius of the rescue , less time consuming of endotracheal intubation （ including airbag - mask oxygen administration ） and using of defibrillators and witness involved. Implementation of professional pre-hospital emergency could increase success rate of pre-hospital CPR.